


Fight or flight

by belis



Category: The Avengers (Marvel Movies)
Genre: Angst, Bipolar Disorder, Fluff and Angst, Gen, Implied/Referenced Self-Harm, Mental Breakdown, Mental Health Issues, Psychologists & Psychiatrists
Language: English
Status: Completed
Published: 2018-05-27
Updated: 2018-05-28
Packaged: 2019-05-14 09:21:51
Rating: Not Rated
Warnings: No Archive Warnings Apply
Chapters: 9
Words: 13,314
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/14766878
Author URL: https://archiveofourown.org/users/belis/pseuds/belis
Summary: This story was inspired by the panic attacks theme from Iron Man 3. Tony struggles to cope with symptoms of PTSD and decides to seek professional help from a psychiatrist. As can be expected things do not go exactly to plan. Avengers support Tony through his slow and tortuous recovery. Warning for mention of suicide attempts.





	1. Chapter 1

**Author's Note:**

> This story is being moved over from Fanfiction.net
> 
> I come from a science and clinical background and my writing skills are not particularly amazing. I like to play around with ideas of characters from film and TV experiencing mental health problems so after seeing Iron Man 3, I just could not resist developing that theme. There are no graphic descriptions of self-harm in this story but please be warned that it goes beyond anxiety and towards depression and severe mental illness, including suicide attempts.
> 
> Any comments are always very much appreciated. :)

Tony was exhausted. He had willed himself to stay awake for as long as possible dreading what was going to happen when he fell asleep. He'd wake up to his own screaming, drenched in a cold sweat, plagued by recurring nightmares.

During the day, it was another struggle; he was troubled by flashbacks, all relating to either New York or Afghanistan. At times he was aware that they were just products of his imagination, but sometimes they were so intense that for the short duration that they lasted he would completely lose touch with reality, reliving the experience as if it was happening all over again.

He tried to avoid any potential triggers. It became more and more difficult, even the slightest reminder was sufficient to set him off. He had become irritable and prone to angry outbursts. Jarvis and Dummy had felt the brunt of it on account of the fact that he spent most of the time in his lab, isolating himself from the world. He felt depression slowly creeping in. He hadn't felt so low since he'd been convinced that he was going to die from palladium poisoning.

Tony stared absentmindedly at an unfinished project on his desk and amongst a pile of papers, he noticed a small card with a name and a phone number. Pepper and Bruce had been trying to convince him to get some help for his anxiety for weeks. Bruce had done his best, but he was 'not that kind of doctor'. He wanted Tony to see a specialist. Dr. Sullivan was a rising star in the field of PTSD research, Bruce had said, worked closely with the military and had the necessary clearance. May as well give it a go, he thought.

Tony mustered up the courage to go. He did not call to make an appointment, however. Too much fuss. He decided to just turn up at the office, which to Tony, somehow seemed fair. When he got there, the receptionist tried to stop him, but he pushed by her with a confident smile. He stopped short at the door to the office convinced that he must have been in the wrong place. He had expected to find a male psychiatrist. Instead, behind the desk, there was a somewhat young looking woman. For a minute he entertained the thought, that she was a secretary or a personal assistant, but she looked a little bit too comfortable, leaning back in the huge chair with her legs resting on top of the desk. She raised her eyebrows in surprise and looked at the receptionist that was just behind him.

"I-I tried… to tell him… not without an… appointment!" She gasped, clutching her chest slightly.

The plump lady, obviously aged into her forties clearly struggled to catch her breath after a brisk run down the corridor. She took an inhaler out of her pocket and took a deep breath. Tony could hear a loud wheeze as she exhaled slowly. Watching the woman struggle made him suddenly uncomfortable with his own breath catching at the back of his throat. He quickly shifted his attention away from her, focusing instead on the smart interior of the office.

"It's OK, Gemma. I'll take it from here. Why don't you take a break? I think you should swing by the clinic room and see Debbie. It sounds like you may need a nebulizer."

"Thank you Dr Taylor" Gemma turned around and gave Tony an evil look. She took another puff of her inhaler and disappeared down the corridor, muttering to herself about useless security guards.

"Now, how can I help you, Mr. Stark?"

Nicola was slightly irritated by the interruption to her lunch break. This sort of thing had been a daily occurrence in a busy hospitals, but now she was supposed to be enjoying a relaxing six months of sabbatical concentrating on pro-bono youth work at the clinic. Emergency consults were definitely nowhere on the agenda. She quickly dismissed her annoyance as she quickly became somewhat intrigued. It wasn't an everyday occurrence, to have celebrities storming into her office.

"Hello, Mr. Stark?"

As she focused her attention on him, she realised that Tony's gaze was somewhat dazed and his breathing was accelerating rapidly.

"I've clearly missed the memo informing me that I've been transformed into a pulmonologist. Are you also an asthmatic?"

Tony shook his head vigorously but no matter how hard he tried, no words came out of his mouth. Nicola thought for a second, and a flash of recognition appeared on her face. "Aha," she thought, "...if this is what residing in this office is going to be like, I might look for alternatives." Dr Sullivan had reassured her, that he had made arrangements for all his patients and all he had asked, was that she kept an eye on his precious office plants. It had sounded like a perfect arrangement, whilst her office was renovated. Obviously, her friend had not exactly been forthcoming with the possibility of billionaire walk-in's.

"Are you here to see Dr. Sullivan?"

That was the man he was looking for. Tony nodded vigorously in agreement. Hopefully he was simply in the wrong office and this whole embarrassing confusion was sorted quickly. No matter how hard he tried to convince Pepper and Bruce that he was fine, his panic attacks were quickly becoming unbearable.

"It may not be the best time to tell you this, but he is giving a series of lectures… in Europe… for 6 months…"

Nicola watched, as Tony slowly slid down the door frame to the floor.

"There are many other excellent PTSD specialists that I will be only too happy to recommend. Let's deal with the urgent matter on hand first though. If you carry on breathing at this rate any longer, you' ll get nasty pins and needles all over. Try to focus on my voice, ok? You are in a safe place; everything is under control. All we need to do now is work together to slow your breathing down."

Nicola, alert at the desk now, came from around it in a calm manner and sat on the floor in front of Tony, making sure that he could see her face clearly.

"What I want you to do is take a breath in for 5 seconds, hold it for 3, and exhale for 7. I will count and model it for you. Just try to approximate what I'm doing. It will take a few minutes, but you'll get there, alright?"

Tony could hardly see with the office floating away from him and intrusive flashbacks trying to force their way in. He tried to listen to the woman. She sounded calm and reassuring. He could hear her counting in a steady monotone. Minutes passed. It seemed like hours, but he gradually started feeling calmer. The doctor's face came into focus. She was breathing calmly and counting. What did she say, inhale for 7? Tony tried to remember the instructions, but then resorted to copying, what she was doing.

"Vitals, Jarvis." he said quietly.

"You are doing well, Sir. Your heartbeat and respiration rate are slowing down and the carbon dioxide levels in your blood are back within a normal levels. I suggest, that you continue to follow Dr. Taylor's instructions, Sir."

Had he programed Jarvis to always collude with the professionals? Feeling better, Tony got off the floor abruptly and decided to leave as soon as possible. He wanted to be back in his lab, where he felt safe at least most of the time.

"Are you feeling a bit better?"

Nicola had also gotten up and was now looking at Tony in that professional, reassuring manner, that Bruce often assumed.

"Y-Yeah...uh, look, thank you. Sorry for all the trouble. I'll be on my way out." Tony, on his way out door, stopped for a moment and thought about something momentarily before turning around and pointing his fingers towards her, "Feel free to send me a bill, Sweetheart. Don't worry, I expect it to be extraordinary, considering it was an unscheduled appointment and the… ehm… collateral damage to your employee."

"It is a pro bono clinic, Mr. Stark, but I think I will consider this an exception."

Tony could swear that he had seen a mischievous smile on Nicola's face, but it had disappeared in the blink of an eye only to be replaced by the look of professional concern.

"How did you get here, Mr Stark? Have you got a chauffeur or some sort of magical robot machine to take you places?"

"Ehm… no, I- uh, drove."

"I thought so." Nicola glanced again through the window at a sports car parked nonchalantly across two disabled spaces and blocking some poor soul's Mitsubishi.

"I don't think you are fit to drive just yet. Please, take a seat and make sure you recover fully."

Tony considered this for a second. His breathing had calmed down, but his hands were still shaking uncontrollably, his mouth was dry, and he could feel a nasty headache coming on.

"No, you know what, I think I'm fine. I'll just be-"

Nicola raised an eyebrow, looking down at the hands he attempted to ball into fists to calm.

He cleared his throat, looked away and smirked, "Got any scotch?"

"A glass of water then." She corrected with a smile.

He was fully expecting to be banished into a waiting room to face the receptionist again, but Nicola led him to an adjacent room, which was furnished comfortably with sofas and an array of huge cushions scattered across the floor. He took the glass of water offered and sat on the sofa, planning to rest for just a few minutes.

"Take your time." Nicola gave him an encouraging smile and disappeared into her office, quietly closing the heavy door behind her.

Tony came around slowly, wondering where he was. He looked around the smartly furnished interior and focused on diplomas and prizes in mahogany frames on the walls . All belonging to the mystery doctor, Dr. Sullivan.

No wonder they want the guy to do a damn tour of Europe with his show. Tony got up and was glad to realise, that his headache was gone and he felt quite refreshed. He looked out of the window. The sun was going down. "That was one long nap. I'll bet the good doctor is impatient to get rid of me." As he approached the heavy doors dividing the two office spaces, he realised that Nicola was not alone. He could hear her talking with a child, who was around 5 years old. It seemed to him, that they were playing house or something similar. It isn't that surprising really, why wouldn't she have a child? Tony was about to knock on the doors and enter, when he heard the child scream suddenly and start recounting the sort of trauma, that he would never expect a small child to be a part of. He quickly backed off, embarrassed that he had intruded on what was clearly a very private interaction. He sat back down, as far away from the doors as possible.

"Jarvis, play me the 'Mob Rules' album and make it loud." He definitely did not want to hear any more of the screams or the story. Half an hour must have passed, before he saw the doors opening. He could not hear the knocking over the heavy metal music blaring in his ear.

"Black Sabbath? Good choice, bit loud though." Nicola had her suspicions, as to why Tony had decided to deafen himself with music. It was not an ideal situation that he was still around, when she had another patient next door.

"I didn't want to intrude on that girl's privacy… kind of awkward…" Tony felt himself grimace at the recollection of the snippets of the conversation and horrific screams that had reached his ears.

Tony took a look around the office as they moved next door and was shocked by the devastation. The large doll house in the middle of the room remained intact, but the inhabitants had fared less well. The floor was covered in little mutilated bodies. Nicola gave Tony a careful look, concerned for a second that this could trigger some battle scene memories or other disturbing flashbacks, but he looked calm and relaxed.

"You would think that they made those therapy dolls a bit more robust." Nicola sighed as she deposited a neat pile of casualties on her desk. "Take a seat, I will give you a list of PTSD specialists. There are a large number based locally."

Tony watched as Nicola logged into her computer and scrolled through some files. He picked up the dolls one by one and busied himself reattaching heads and limbs in an absent minded fashion.

"Could I not just carry on seeing you instead?" He asked quietly. "Jarvis told me that you are an expert in an area of PTSD yourself."

He thought that it was a long shot considering his behaviour in the morning, but he wasn't so sure he could face meeting another therapist. The more people out there, who knew about his 'problem', the more uncomfortable he felt. Plus, she seemed like someone he could get along with, an easygoing kind of person.

"I thought the props gave it away, Mr Stark. I am a child psychiatrist. I am sure though that one of my colleagues will be able to help." Even Tony could tell that the consultation was over.

On the way home Tony thought carefully about his options. The logical thing to do would be to look through the list that Dr Taylor gave him, pick up another psychiatrist and call them in the morning to arrange an appointment. Or he could ask Pepper to arrange it. Simple problem solving. That was, what adults were supposed to do. He could not stop thinking about what had happened that day though. He had had a total meltdown within minutes of arriving at the office. What was going to happen during a proper consultation, when he was asked probing questions and forced to remember… The sound of impatient beeping brought his attention back to the road ahead. The light had changed and he was blocking traffic. Better concentrate.

When Tony arrived home, he was greeted by a worried-looking Pepper.

"Where have you been, Tony? We were supposed to have dinner together, remember."

She wasn't angry, but he could clearly recognise the disappointment in her eyes. He had messed up...again. No matter how hard he tried, it seemed, he always messed things up.

"I went to see someone… that psychiatrist that Bruce recommended…" Tony avoided eye contact with Pepper.

She was surprised, and the disappointment was gone. "Tony, th-that's great! How'd it go?"

"Just great, yeah. The Doc's a natural, what can I say? So fantastic, in fact, that he spends his time touring Europe rather than seeing patients. So he's out."

Pepper's smile fell.

"There is another psychiatrist working there now, and yeah she was real helpful. I thought great, I can trust this one, let's get this project off the ground. But no, that would be just too easy. The one therapist that I seem to get along with turns out to be a pediatrician." He crossed the room, grabbing a cup with an angry swing and poured half a cup of a scotch, then paused, thinking better of it, he poured a full glass. "But maybe that's exactly what I need, everyone keeps telling me how immature I am. Don't you find it all kinda...ironic?"

Tony realised that he was rambling and that little of what he had said would make any sense to Pepper. He felt too overwhelmed to explain, and suddenly, a volt of anger rising in him, so he turned towards the elevator and headed for the safety of the lab, leaving a gobsmacked Pepper in the hallway, with concerned eyes and folded arms.

Tony spent the next couple of hours tinkering. He wasn't working on anything in particular, just trying to distract himself, focus on something else than the anxious thoughts relentlessly trying to intrude into his mind. Like evil spirits trying to fester in his brain.

He was desperately trying to avoid going to bed. He couldn't face the nightmares. He'd seen a new grey hair patch in his goatee the other day, and that..that was just about the final straw. He could not face Pepper. He knew that he behaved like a total jerk and he was surprised that she had put up with this for so long.

Bruce entered the lab and watched him for a few minutes. Tony was just flipping through old project schematics absent mindedly, half hoping that Bruce would have something other than the abject failure of a therapy session to talk about. Tony really didn't want to talk about all the ways in which he was weak, again. He'd fixed the Palladium problem on his own, he could fix this.

Of course, he'd needed dear old Dad's help for that and the one person who'd been able to help had sent him off with a list of faceless names. Fuck.

This wasn't like—he couldn't just pump himself full of antibiotics and be fixed. Not even Bruce had been able to help.

"Not that kind of doctor," Bruce muttered from over his right shoulder; great minds think alike apparently.

"Tony, can we talk for a second?"

Tony turned to face him, aware that the nap on Dr Sullivan's couch hadn't done anything for the circles under his eyes.

"Pepper told me what happened," Bruce said, "Seeing Dr Sullivan didn't exactly go to plan?"

"That's an understatement. I would say that it was a fucking disaster. It's proven to me that I'm no longer capable of interacting with another human being without turning into a quivering wreck. I'm so fucked that even a psychiatrist doesn't want to be in the same room as me."

Tony waved his hand abruptly, bringing his glass of whiskey to his lips with his other hand, making the images flickering around him disappear. Now he had to think about a way to make Bruce disappear. He was proficient at that, pushing everyone away, as far as possible.

"Wait a second, Tony. The reason why Dr. Taylor didn't agree to see you is that she is a children's shrink. Dolls, drawings, soft toys, the works... I'm fairly certain that she didn't pass any judgment on you, Tony. That is really not her style."

Bruce chuckled softly at some memory, his voice fond and familiar.

"Wait a second, you know her?" Tony was somewhat confused.

"Not really. I know that she is a very good friend of Sullivan. They worked together on a big research project at one point. I met her once in Cambodia. She worked with an NGO that set up a project in a village where I was hid-… working, I mean."

Tony gave Bruce a weak smile. "Small world isn't it."

Bruce took that as an encouraging sign. "Listen Tony, I know it must have been disappointing for you, but we can fix it easily enough. I can arrange an appointment for you tomorrow with…"

"No, thanks, Brucie-boy." Tony interrupted Bruce rather abruptly. "I'm done with seeing professionals. I can cope with this on my own." Tony brushed past Bruce out of the lab and into the dark corridors of the tower, shouting to Jarvis to prepare something Bruce could only understand half of through the thick slur in his words.

Bruce watched Tony get up and leave. He could see just how upset he was, and he briefly considered following him but after a second thought, decided against it.

"He...needs some space. Jarvis, can you keep an eye on him?"

"Of course, Mr. Banner. Already am."


	2. Burning issue

Tony curled up on a sofa in the library. He felt confident that no one would think to look for him there. All he wanted to do was rest. He was going to close his eyes for a little while. He didn't want to think what he needed to do in order to sort things out with Pepper and Bruce. How to get out of this mess he got himself into. Before he knew it, he has fallen asleep, complete exhaustion overriding his restless mind.

The wormhole. All he could see was the giant wormhole in the sky. He knew what he had to do. He had to close it, no matter what. No matter the cost, the price, the devastation it would leave. That was the only way he could keep Pepper safe. She would understand. If only he could say goodbye. If only he could explain. The phone keep ringing and ringing. He could see the explosions around him, like hell's gate. He just reminded himself, he needed to stop it. He had to stop it. Or everyone he knew, loved, cared about would be dead and he'd be blaming himself for one more thing. And then there was just silence. Terrifying silence. He could not breathe. There was no oxygen. Just like being underwater, like the water torture in Afghanistan. Slowly drowning…

"Miss Potts, I am sorry to disturb you at such a late hour but I believe that sir requires some urgent assistance. His vital signs indicate that he is in a great deal of distress and he has been calling for you." Pepper put on the night light and slipped her bare feet into flip flops.

"Where is he, Jarvis?" She asked quickly, her whisper was sharp and concern had driven out any sleepy haze.

Upon entering the library, Pepper was immediately drawn to the dark figure on the sofa. She could hear Tony tossing and turning in his sleep.

"Not another nightmare..." She muttered under her breath, looking for a light switch. As she stumbled in the dark, she saw her surroundings becoming lighter, not too bright, but comfortable. "Thank you, Jarvis." She approached Tony carefully, not wanting to scare or distress him any further. "Tony, wake up. You're having a bad dream." She put her arm on his shoulder and shook him gently. She watched his eyes snap open. They were initially unfocused, darting around the room before they rested on her face.

"I tried to call. I wanted to explain. I'm sorry. I just mess everything up…" He explained in one breath and swallowed, trying to get his mind up to speed.

Pepper pressed her finger gently against Tony's lips. "It's okay. You don't have to explain anything. Just..try to relax, Tony." Pepper was acutely aware how quickly Tony was breathing. He was pale and covered in a cold sweat. She considered calling Bruce, but then reassured herself that this had happened before. Many times, in fact. But the initial fear she had at the state he was in every time woke from these nightmares made her wonder if she was doing all she could.

"It'll pass, Tony. It always does... It was just a nightmare. You're..." She yawned as she allowed herself to calm as well, knowing he was safe. "...safe now."

Tony really awoke in the bedroom. He had a vague recollection of Pepper coaxing him out of the library last night. Jarvis must have called her. Judging from the absence of Pepper and the bright light coming in through the window, Tony deduced that it was later in the day. It looked like he finally managed to get some sleep. 'Hey, maybe I'm finally getting somewhere.' Tony thought. Feeling slightly more optimistic, Tony made his way to the kitchen to be surrounded by the usual pandemonium.

Natasha and Clint were discussing something loudly, both gesticulating vividly. It was always hard to tell if they were at each other's throats or just engrossed in conversation. Bruce was oblivious to them both and completely immersed in his morning paper. Thor was messing around with the toaster to the best of his ability, and upon burning something as usual, yelled some words everyone had eventually agreed upon were some form of curse words native to his home planet.

Burning…That's when it hit him. The smell was overpowering. It was dragging him away from the safe, sunlit kitchen and to the dark places where he really did not want to go. Afghanistan, where children burned in fires made from his weapons.

"Man of Iron, will you join us? We are just about to break the fast with some of these delicious Pop Tarts." Thor paused and looked over Tony with a concerned eye, "Man of Iron, are you not well?" Tony was growing paler by the second right in front of his eyes.

The kitchen was friends were gone. New York was gone. He was back in Afghanistan. Right in the middle of the ambush. Gun fires, explosions, thick smoke all around him, squeezing its way into his nostrils, making it harder and harder to breathe. His chest ached. Was it just from the smoke inhalation? No, now there was blood. So much blood. He was injured. There were snippets of conversation reaching his ears. People were shouting in a harsh foreign language. He couldn't make sense of what was going on. All that registered was pain. Pain that made it impossible to breathe. Suffocating and overwhelming. Children burning, people dying, all because of him.

Bruce put his paper down and watched Tony over the rim of his glasses. He watched him stagger and fall to the floor as if in slow motion. It had happened before. It was not in itself alarming. Panic attacks are unpleasant as they may be, but are not life threatening. What he really did not like was Tony's colour. He wasn't just pale; he was rapidly turning grey. His face was covered in sweat.

"Natasha, can you get my bag?" He moved quickly across the kitchen, his eyes glinting green. Everyone knew that this meant serious business. Bruce kneeled on the floor gently pressing on Tony's wrist to feel his pulse. He frowned and moved his hand towards Tony's neck. "Jarvis, what the hell is going on?" He could not find a pulse in Tony's wrist and struggled to find the carotid one.

This meant his blood pressure must have been very low. He was hyperventilating, but there was an unmistakable blue tinge of cyanosis to his lips. This was not adding up. Not to a panic attack, anyway.

"Tony is currently experiencing an episode of ventricular tachycardia. His heart rate is two hundred and twenty beats per minute, and his blood pressure is severely compromised at sixty-forty. In view of the considerable risk of further deterioration of this rhythm into ventricular fibrillation, which is not compatible with life, I think it would be appropriate to utilise the ID function of the reactor.

"Couldn't agree with you more, Jarvis. Please, go ahead." Bruce watched Tony's body jerk ever slightly. He felt his pulse again. It was slowing down and felt much stronger.

"Back to sinus rhythm. Should I call an ambulance, sir?"

Bruce considered that for a second. He knew from Tony's file that he had experienced episodes of VT before. There were triggered by abnormal conduction in the scar tissue within his heart muscle. They were more frequent in the initial couple of months after his heart surgery. If Yinsen managed to successfully manage them in a cave, they should be able to do so in the tower with all its technical back up. "No, I think it's alright, Jarvis. We're over the worst of it...I hope."

Natasha returned with Bruce's emergency bag. He rummaged through it and retrieved a portable oxygen cylinder. He slapped the mask on Tony's face and watched with some satisfaction as the color gradually improved in Tony's face. He placed Tony gently into a recovery position and turned to the others. "If he comes to before I come back, try not to ask too many questions. Reassure him, let him talk shop with Jarvis; he will be able to explain to him what went wrong with his ticker. I have to make a phone call."

Bruce fumbled around in his pocket, looking for a mobile phone - without success. "It's time to call in some favours. Any chance you can find out where the hell Dr. Sullivan is?"

"Would you like me to put you through, sir?"

"Efficient as usual." Bruce nodded in approval.

"Connecting you to Mariot Hotel in Stuttgart, Germany, Sir. The local time is three in the morning."

"Good."


	3. Requesting reinforcement

Bruce stopped in his tracks.

One thing that he knew about psychiatrists was that they were not accustomed to work waking them up in the middle of the night. If he created an impression that this was a situation that could not possibly wait 'til morning, he can be sure that Sullivan would start murmuring about psychiatric ER and compulsory assessments—not the situation he wanted to put Tony in if it could be avoided.

"Wait a second, Jarvis." Bruce sighed, retracing his thoughts and hung his head slightly, pinching the bridge of his nose, "No, this isn't right. I can't really wake Dr. Sullivan up at this hour..." Bruce paused, "Could I? No. No, I couldn't. I'll just talk to him later."

Bruce found himself shaking his head and mumbling to himself that he wasn't going to turn into Tony and begin demanding the impossible from people.

Bruce returned to the kitchen to find Tony exactly where he'd left him. He was surrounded by clearly worried Avengers, each of them coping with the situation in their own way.

Natasha was quietly conferring with Jarvis to make sure Tony's vitals were stable, cold and calculating she asked him to run through everything again, acting as though this were just her duty on a mission, though her concern was clear. Bruce was pretty sure that she was the one who'd had the presence of mind to cover Tony with a blanket to keep him warm.

Steve had a hand on Tony's shoulder and was trying his best to sound reassuring as he talked to him, not quite sure if Tony could actually hear him. The image made Bruce picture it on the battle field. A crouched Steve Rogers by his fallen comrade, assuring him help was on the way. His baritone took on an undeniable authority.

Clint was perched on the work top looking rather tense, one leg bent against his body and the other hanging, kicking at the compartments below silently.

Thor did not seem too fazed by the situation; he was sitting at the table, eating his breakfast while trying to encourage Clint to join him.

"Come on brother. Bruce is an experienced healer; he knows what needs to be done. All we can do now is wait for the Man of Iron to return from the Valley of Shadows. Worrying is not going to help any." Upon noticing Bruce's return to the kitchen, Thor then turned to him. "Brother Bruce! The man of iron continues to give us all a great concern. He has not stirred since you have left the room."

It was then that Tony slowly began to regain consciousness. The first thing that he became aware of was the cold permeating from the tiled kitchen floor he was lying on. He shivered slightly and was grateful for the blanket over his shoulders.

"Tony, you OK? You just had a funny turn, that's all."

Steve said as he noticed that Tony began coming back to the real world, anxious to try and keep him calm as Bruce had instructed. Tony sat up suddenly and opened his eyes, taking in the surroundings. He felt painfully aware that he just had a meltdown in front of everyone. He looked at a kitchen clock and realized that he lost at least half an hour.

The pity seeping from everyone made Tony suddenly very aware of a dire need to escape. He couldn't stand the concerned looks for a second longer. All he wanted is to be back in the lab, away from people before they started asking him questions.

He pulled the oxygen mask off his face and tried to scramble to his feet.

"Sorry cupcakes… I need to get out of here… get some fresh air, or some really good scotch..or..or..."

He felt Steve's hand on his shoulder, pulling him back, gentle at first but firm all the same. Bruce handed him the oxygen mask with raised eyebrows.

"100% oxygen. It doesn't exactly get any fresher than that. Come on Tony, work with me here."

Tony reluctantly took the mask and inhaled a deep breath. He felt like he needed it. Something was telling him that what he had experienced was not just a panic attack.

"What happened?" He looked questioningly at Bruce, trying to read his facial expression. He did not like the look of professional concern that Bruce was sporting at the moment.

"You had an arrhythmia, Tony. I'm not sure what exactly set it off; Jarvis treated it successfully with electrical cardioversion, but we should probably give you a quick once over, check the reactor and..."

Bruce stopped mid-sentence as he watched the expression change on Tony's face. There was a quick flash of pain and pure dread. The memories of his experiences in Afghanistan were again trying to force their way to the surface. All he could think about was the car battery and the searing pain of electrical shock making its way across his chest.

Yinsen had had his best interests at heart, but the treatment that he had to offer for VT seemed worse to him then the condition itself. Tony took another deep breath and brought himself back to the present.

"Yeah, ya' know, you're right Brucie. Why don't I just go to the lab and Jarvis can run a few diagnostics over there?"

Tony was already beginning to get to his feet when the persistent hand of Captain America was pushing him down again.

Bruce smiled and shook his head.

"Nice try Tony, but if you think that I'm just gonna let you hide away in the lab after you narrowly avoided a cardiac arrest, you must think I'm an idiot. Steve'll help you get to your room, I'll be in there with all the equipment shortly, we need to run remote diagnostics."

Tony grimaced and Bruce smiled knowingly, "Doctor's orders. No arguing this time."

"Thought you weren't that kind of doctor..."Tony mumbled beneath his breath and Steve wrapped an arm around his back and pulled him to his feet in a quick motion.

"Hey, slow down. Let's just stop by the mini-bar real quick and-"

Bruce snorted, "No, Tony."

"For Christ's sake, one drink. One drink could really make a difference? Cap, tell me if I'm wrong, but didn't you guys used to drink at least a bottle before a doctor started probing with your heart?"

"Get off it, Tony." Bruce called, the faint grumblings could be heard all the way down the hall, and it wasn't until the shutting of a door was heard, that it stopped.


	4. Buying time

**Notes for the Chapter:**

> I'm guessing that if you got to chapter 4, you must be comfortable with and interested in reading about mental health issues. Nevertheless there is a health warning for this chapter and upcoming ones because of references to suicidal ideations and generally self-destructive behaviour including drinking more than is good for you. I do not intend to include any graphic descriptions of deliberate self-harm in this fiction at any point but the subject matter is getting a bit dark and depressive.

Tony finished the diagnostic on the arc reactor and was flicking through the results on his tablet. Everything was in order. He continued to stare intently at the graphs, trying to avoid the impending conversation with Bruce.

"How's it looking?" Bruce asked as he discontinued all the wires and peered over Tony's shoulder. He could read the 12 lead ECG, which was fine, but was not quite sure about some of the more intricate aspects of the reactor's performance.

"Oh, fine, peachy. The reactor's not exactly the issue." Tony brought his hand to his chest and looked down at the reactor. He cleared his throat and shrugged at the memory. "Heart's the problem...Yinsen warned me that this sort of thing could happen. That's why the reactor has a built-in ID function."

Bruce momentarily admired the work that had been put into the device, eyeing the glow of it beneath Tony's shirt.

"I'll just...take some blood. It could have been triggered by an electrolyte imbalance, you know."

"Naw," Tony shook his head, "No..."

Bruce looked back up to him. Tony was busying himself with his tablet as an obvious distraction. Tony looked back up out of the corner of his eye and sighed, putting the device down, and continued slowly.

"I already know what caused it."

Bruce stopped arranging the blood bottles and looked at Tony in anticipation, waiting for him to elaborate. He didn't, though. Instead, he turned away calmly and stood, putting his hands into his pockets, his head bowed.

At the sound of Bruce's feet shuffling, Tony folded his arms across his chest and took another step.

"You know I can't help if you don't cooperate…"

"You can't help me." Tony murmured darkly, "You try to be such a fucking optimist, well the jig's up. The show is over. Don't you fucking see? I'm past the point of needing to cooperate or some professional help. I'm-" His voice cracked and Bruce's eyes widened for a moment.

Tony Stark-...no, he wasn't. Tony didn't...

Tony shook his head, "I can't even talk about it, you know. Can't even talk about…" He silenced himself at the words Afghanistan and New York. tIt'll just bring on another..'nother..." Tony made a signal with his hand like a firework, "..flashback! No matter what I do, there's another trigger around every corner. I'm messed up and there is no way out of it. Just… stop trying so hard! It makes me fucking sick. I'm not… " Tony swallowed again, and the shaky intake of breath Tony took made Bruce shiver. "Get out. Just…get out."

The deathly tone alerted Bruce and when Tony turned around just enough to see his tear-streaked profile pointing at the door, his denial was cured. Tony Stark, the man that's soul was comically questionable at times, was openly crying. He no longer cared about maintaining any sort of pretence, and even if he did, he was simply no longer capable. There were no jokes, no more cheap laughs.

Bruce realised that he had headed deep into the 'not that kind of doctor territory' and was out of his depth. He retreated back to what he knew. He cleared his throat, backing away slowly.

"Let's get you started on some beta blockers, Tony. It should minimise the risk of any further arrhythmias while we try to sort out the …the...uh underlying issues."

Back in the kitchen, Bruce made himself a cup of coffee and started flipping through his papers again.

He couldn't concentrate on what he was reading, but had to kill the time until he could talk to Sullivan somehow.

He felt out of his depth, more so then when he was confronted with an outbreak of cholera in the slums of New Delhi. Despite limited resources, he felt that he could control this situation. Replace what comes out, monitor vital signs, trouble shoot with inotropes if need be. That was the kind of medicine that made sense to him: logical and scientific, and somewhat detached. For him, psychiatry was on par with black magic. Sure, it was firmly based in science, and you could focus on the synapses, receptors and various psychotropic, but one could not be successful without embracing the human misery and jumping right in with both feet into the terrifying pool of emotions. He was finding the situation particularly hard since Tony was a close friend, but he had never been good in dealing with mental illness. It scared him.

"How's he doing?" Steve asked as he got himself a cup of coffee and sat opposite Bruce. "You know...it kind of freaked us all out… you know, this morning. I'd noticed that Tony was a bit more irritable, not exactly himself, but I would have never thought that things were so... serious. I don't really know what to say to him when he's like that. He shuts himself away from us and it's so hard to get through to him sometimes…"

"Tell me about it.." Bruce whispered.

Steve rubbed his hand through his hair and looked up for any sign of advice from Bruce.

Bruce put down his paper. "I feel like I'm bashing my head against a brick wall sometimes. I guess all we can do is keep an eye on him. I'm trying to organize some God damn professional help, but sometimes it feels like we're the only professionals." Realizing his sudden outburst, he shook his head and looked away, slightly ashamed, "In the meantime, the main thing we gotta do is just make sure that knows that we're around if he needs us."

Steve shifted in his seat uncomfortably. "Bruce… do you think that he would… I mean, I know that he can be pretty self-destructive at times with all the drinking and sleepless nights and not eating but do you think he would…" Steve was scared to say it aloud, as if it was likely to make it any more true. He was also worried about making Bruce uncomfortable, considering his past struggles with depression. Coming back stronger, Steve rested his elbows on the table with a determined eye, "…he would do something to himself… on purpose?"

"I.." Bruce had of course, thought about it and came with a comforting solution, "Jarvis has constant tabs on him, if he does try anything stupid." Bruce looked again at the kitchen clock. It was breakfast time in Germany, a civilized enough time to make his phone call.

"Why don't you try and talk to him? Who knows, maybe he'll actually take the matter seriously and not avoid every question you throw at him. Hell, he might even pour his heart out to you and make me look like a royal dumbass. Sounds like Stark's cup of tea, doesn't it?"

Bruce took a breath, pinching the bridge of his nose and swallowed. Steve couldn't help but notice the green tinge in his eyes just before he snapped them shut.

"I'm...I'm sorry. I Just...I need to make some phone calls."


	5. Compromise

It was hours later when Bruce went back to Tony's bedroom to bring him some Atenolol.

He wasn't exactly surprised when he discovered that Tony wasn't there, but disappointed to some extent that things couldn't just be easy for once. Without much thought, he turned around and headed for the lab with half-lidded eyes. He thought through a plan just in case.

In case what?

In case Tony wanted to be left alone? In case the door was locked down? In case Tony wasn't there at all?

He held his breath and attempted the door, eyes closed and prepared himself for the worst. He was relieved to find the door was unlocked and even gave a sigh of relief. He would've smiled if his mind hadn't been rushing to the next topic: what lied behind this door?

He couldn't say he was pleased at what he found behind them. As soon as he entered he was deafened by AC/DC blaring from the sound system. He watched the walls and floor vibrate to the bass of the music. He frowned when he saw that Tony was sitting at the desk, clutching a glass in his hand with an empty bottle of whiskey by his side.

"Hey. Finally. Welcome to the party. Care to join me? I was just about to open another," Tony said as he reached into the drawer and pulled out a bottle of bourbon, glorious as it was, shining in the light and bestowed with the look of love from Anthony Stark, he set it onto the lab table.

"No, Tony, you've had enough." Bruce said and with that, Tony defensively picked the bottle from the table again, ready to fight for it.

Bruce, as Tony had figured he would, tried to take the bottle out of Tony's hands. And as Bruce had expected, he was met with heavy resistance.

"Stop being such a kill joy, Bruce." Seeing that his coaxing wasn't working, Tony pulled back harder, "Stop mothering me, damn it." Tony grunted through gritted teeth.

Bruce let go with exasperation, realizing this would get no where except make him angry. And he didn't want that. Not in the lab, not with Tony drunk.

Tony turned around in his swivel chair and continued to poor the drink.

"For God's sake..." Bruce grumbled with a laugh in his voice and he smiled out of sheer aggravation. There was fury in his eyes and was dumbstruck at the man's behavior. He was not only at a loss for words, but at a loss for what actions he should begin to execute. "You narrowly escaped a cardiac arrest today. Forgive me if I'm a little bit twitchy." Bruce found himself rapidly losing patience, voice quivering with the anger building. He suppressed it again and again.

"Thanks for the reminder, Buddy, Jarvis is just losing his touch. Jarvis, hear that? You're losing your edge. I thought I programmed you to remind me of shit I don't wanna hear about."

Bruce was slightly taken aback when Tony stood up abruptly and threw the glass across the room, letting it shatter on the wall. He was not expecting Tony to agree to go with him straight away, but he especially did not predict this sort of outburst. He took a couple of deep breaths to control his own emotions. The last thing they needed in this situation was a guest appearance of the 'other guy.' He was not quite sure what to say to help Tony calm down, and watched with growing concern as Tony sat back down, clutching his chest.

Cardiac arrest. His heart not beating. Dying. That was all that Tony could think about. Out in space, slowly suffocating. Paralysed and helpless watching Obadiah rip the reactor from his chest. In a dark cave, being resuscitated with a car battery.

Tony was desperately hoping to cling to reality. There were so many memories lurking on the verge of his consciousness, ready to take over and send him into yet another panic attack. The lab was coming in and out of focus as he was trying to concentrate on Bruce's face. He was sure that he had seen the unmistakable flash of green in the other scientists' eyes. Great, he thought, even Bruce is getting pissed off with me now. "Da-...Damn i-it...I'm sorry," Tony muttered under his breath.

Bruce came closer and took hold of Tony's hand to check his pulse. "Here, take one of these. I'm not having a repeat of this morning." He shook his head in disbelief, watching Tony wash down the beta blockers with bourbon straight from the bottle. "Now let's get you into bed. Pepper's back and she's getting worried. You want that, Tony? I wont be your only annoyance then."

It was the following evening when Bruce finally got the call he had been waiting for.

"Dr. Banner? Hello, it's Dr. Taylor." Nicola felt slightly apprehensive as she was not exactly sure what she was walking into. Sullivan made her believe that the situation was pretty dire, but then he did like to overdramatize things at times to get what he wanted.

"Thanks for getting back to me. I was...to be honest...starting to lose hope that you could be persuaded to help us out." Bruce had not exactly breathed a sigh of relief yet, but he was hopeful that if Nicola decided to call him back, it meant that she would take the case on.

"Dr. Sullivan had some difficulties getting a hold of me. We organised a camping trip for the outpatients. Phone reception was pretty dire…"

"Seriously?"

"That is the whole idea of a sabbatical. Doing fun things and calling them work. It was a great success from clinical point of view. Confidence building, teamwork… Back to the matter at hand, though. Dr. Sullivan explained your concerns to me. I can see Mr. Stark tomorrow if you think that the situation is...urgent."

"So you will take him on? Despite his age?"

"It is up to him, really. I still think that he would be better off with one of my colleagues who sees adults routinely. They have better access to appropriate support groups, inpatient facilities and so on. Dr. Sullivan seems to believe, though, that my expertise in dealing with 'trust issues' may be more useful at this stage. I can discuss the pros and cons with him and then he can decide." Nicola quickly flipped through her diary. "I have an opening for 10 o'clock."

Bruce was extremely grateful for the urgent appointment, but he had some reservations about being able to persuade Tony to show up after his recent outbursts. "Any chance we could make it a home visit? We had been having a hard time getting Tony out of his lab recently."

"I generally try and see patients in my office, with the exception of those who are so unwell that they need to be seen at an ER or police station."

"Police station?" That was not a setting were Bruce would picture Nicola.

"Never a dull day in child psychiatry. Particularly if half of your case load comes through the juvenile court," Nicola laughed. She considered her options for a second and decided that at this stage the best way forward was to give Tony as much control over the situation as possible. She was pretty sure that if he felt cornered his response would be to point blank refuse to see her. "Just ask him to give me a call when he feels up to it."

She paused thoughtfully.

"I'm sure we can get something sorted."


	6. Starting point

Early next morning, Pepper found herself sat next to Tony in the waiting room outside Sullivan's office. It was warmly lit and furnished with comfortable armchairs. Pepper put down the magazine she had been flicking through and smiled at the receptionist, who seemed to observe them with a degree of suspicion that Pepper could not quite understand.

"Can we go home, Pepper? We could reschedule it for some other time" Tony was fidgeting in his chair and becoming more anxious by the minute. Just as Pepper was about to reassure him for the umpteenth time this morning, the doors opened and Nicola appeared.

"Good morning, Mr Stark. Do you want to come through?" Nicola smiled warmly at Tony and Pepper. She was not expecting an easy ride, but she was very pleased to see that Tony actually made it to the appointment.

"Not really." Tony frowned at Nicola. When he spoke to her on the phone yesterday, coming to this appointment seemed like a good idea, but now that he was faced with a prospect of discussing his most painful memories with a total stranger, no matter how well qualified, this was quickly changing.

"No? That's fine. You can speak to Gemma at the reception desk if you would like to reschedule." Nicola was a master of those waiting room games. The key was not to force the issue. She had time and patience.

"I don't know… If I leave now I will probably not come back, but if I stay…" Tony was trying his best to ignore his racing heartbeat and try to think about the situation logically.

"Well what exactly can go wrong? Last time we met, you ended up having a panic attack. It is not a completely ridiculous assumption that you may have another. Maybe even a worse one. It may be a horrible disaster. On the other hand it may all go swimmingly and you leave my office today cured of your anxiety. In reality the most likely outcome is probably somewhere in between, isn't it"

"Come on Tony. You will be fine." Pepper squeezed his hand in a reassuring manner.

"OK then." Tony sighed with resignation. What could possibly go wrong? Never mind freaking out and making a fool of himself. How about a full blown cardiac arrest triggered by another nasty flashback. Tony was kicking himself for not taking the medication that Bruce had started him on and wondering, how good Nicola was at the 'real medicine'. If she was going to play the same 'not that kind of doctor' card that Bruce liked to utilise, he was screwed.

"Great. Give me a call when you are finished. I have a few errands to run in town in the meantime." Pepper gathered her bag, gave Tony a quick kiss on his cheek and walked out, waving goodbye to Nicola.

Tony reluctantly followed Nicola into the office. She gestured towards a chair and took a seat behind the desk.

"Would you like something to drink?" Nicola was trying to help Tony relax. Her usual routine involved interviewing the parent or a carer during the first session whilst her patient was allowed to play in the room to get used to her and the new surroundings. Now she had to come up with some alternative strategies. And fast. She could already notice that Tony's breathing was quickening and he was grasping the armrests of his chair so tightly that his knuckles went white.

"Cup of coffee would be nice." Nicola busied herself preparing two mugs of coffee in the kitchenette and made a mental note to enquire about Tony's caffeine intake. As she watched him pick up the cup with trembling hands she had an idea.

"I can see that you are very nervous. I am guessing that you are worried that I will start asking you questions and make you remember loads of painful stuff." Tony nodded silently in agreement. There was no point in denying the obvious. His anxiety had reached such a state when it was obvious to even an untrained eye.

"Why don't we turn the tables round? You will be the one asking questions. You can ask me whatever you want, within reason that is." Nicola decided to take a little gamble. She had an inkling that the conversation was going to remain focused on Tony anyway. He may ask some inappropriate questions just to push her buttons, but that was nothing she wasn't used to working with teenagers. She felt that giving Tony a bit more control over the situation was a risk worth taking.

Tony was a bit surprised. He was bracing himself for a barrage of uncomfortable and probing questions. Now he had to stop for a second to think as to what he would like to ask. He watched Nicola as she put some sugar in her coffee and stirred it in an absent minded fashion. Clockwise, anticlockwise, clockwise… He was waiting for her to hurry him along or change her mind and ask a question but she didn't. Tony hated the situation, hated the fact that he needed to be there. He hated to ask for help. That did not change exactly. He did find his anxiety subside a little though.

"Why did you agree to see me?" He thought about that since Bruce asked him to call Nicola and arrange an appointment. He wondered why she had changed her mind.

"Why? It is a good question. There are many reasons. Your friend Bruce can be quite persuasive. I have a lot of sympathy for him at the moment. He has his job cut out for him, trying to be your friend and a doctor at the same time. From a professional perspective this is an interesting case for me, takes me out of my comfort zone and that is important for development. Also it seemed like an intriguing thing to do to get involved in the world of spies and super heroes. The guy with an eye patch was a bit more than I bargained for but then I like a challenge…"

"Fury paid you a visit?" Tony was slightly alarmed but not exactly surprised. He was well aware that Shield was keeping tabs on him.

"Apparently he needs to get you back to work and I am a solution to this problem. He was a bit jumpy though about my lack of security clearance. Strictly speaking I should not be allowed to even look at the cover of your file…"

"He does tend to get his eye patch in a twist about things like that…" Tony smiled slightly and looked up at Nicola. He felt quite comfortable in the situation now.

"So how does that work… you know therapy for PTSD?"

"We start with history taking. That is the part when I do ask a lot of questions. Don't worry though; we won't be talking about any of the difficult things at this stage. I did my homework and read the file you sent me, so I have a pretty good understanding of the background story. What I want to do today is find out more about the symptoms you are experiencing at the moment. I need to take a step back and confirm that PTSD is the right diagnosis before we look at possible treatment options. Does that sound OK?"

Nicola opened her notebook and scribbled 'presenting complaint on top'. She was pleased that her gamble seemed to have paid off and the interview was going right on track.


	7. Contemplation

Bruce was busy in the kitchen cooking some of his famous lentil Dhal in hope that he can tempt Tony out of his lab. He was stirring the contents of the pot and contemplating the events of the past few weeks. It was never Tony's habit to regularly join them for round the table dinners but since the New York he hardly ever spent any time with the rest of Avengers. They all respected his choice but as the time progressed they all became more and more worried. Tony kept himself to himself and aside Bruce and Pepper Avengers had little understanding of how serious the situation has grown. Until the 'toast incident' that is. After Tony collapsed in front of everyone it has become clear to the Avengers that they did have 'a bit of a situation' on their hands. That in turn made it even more difficult for Tony to interact with the Avengers. He was clearly embarrassed and afraid to expose his 'weakness' any further. He did not spell it out exactly but Bruce was able to read between the lines. Bruce was so preoccupied with his thoughts that he did not hear Thor entering the kitchen and he almost jumped out of his skin when a voice bummed behind him.

"What are we going to feast on tonight, brother? It has been many hours since I last had any nourishment." Thor peered over Bruce's shoulder to have a closer look inside the pot. "I must admit that I do not share your love of grains and various curious legumes but the smell of this dish is most inviting. Are we ready to gather at the table?" Thor was clearly getting inpatient. The recent events most definitely did not impact on his appetite.

"Almost ready. Why don't you keep an eye on it and stir it, with this wooden spoon here, from time to time. I will go down to the lab and try to persuade Tony to join us." Bruce has learnt through bitter experience that despite often being eager to help Thor did not posses any skills in the cooking department and had to be guided very carefully if disaster was to be avoided.

"How did your appointment go?"

"OK, I guess. I have a diagnosis now and a management plan… of sorts."

"And what does that entitle?"

"In a nutshell? Drink less coffee, stay away from alcohol, take my meds and try not to isolate myself so much."

Bruce raised his eyebrows and looked pointedly at the unwashed coffee mugs, glass of scotch Tony was holding and a neat stash of unopened pill boxes.

"Yea and how is that coming along?"

"I believe that the technical term is the contemplation stage." Tony flashed him a coy smile. "I am not that great at following doctor's orders."

"Tell me about it, Tony." Bruce pulled a chair and sat next to the other scientist. He picked up a box of tablets that looked new to him.

"Sertraline? Didn't you try that before, around the time of the whole palladium poisoning issue was going on?"

"You mean around the time when I was dying and I did not tell anyone?" Bruce nodded. That what exactly what he was thinking but did not want to say it outright.

"I did try it for a bit, but it did not really make much of a difference… I suppose I didn't take it for long enough… I don't know… It is an option I suppose…"

"I think it sounds like a sensible part of the plan. If you could take your bloody Atenolol as well, I would really sleep easier at night, knowing that you are not at risk of …" Bruce stopped himself mid sentence, realising that he was again starting to lecture Tony. He was a genius for goodness sake. Knew the risks better than Bruce did. Spelling it out was not going to change matters.

"… you know full well what the risks are. Just think about it. In the mean time why don't we go upstairs and check on the dinner. I have left Thor in charge and I am a bit worried for the outcome."

"Fine. I suppose I can then tick off the 'not isolating myself' part of the plan and get you off my back for a bit."

"Deal" Bruce smiled and lead the way.


	8. Natasha tries to help

Bruce was engrossed in his morning paper enjoying a cup of jasmine tea. He was surprised to be joined by Pepper. She rarely had breakfast in the communal kitchen, preferring instead a quick cup of coffee on the go. He gave her a close look and noticed that her eyes were red and puffy. She had obviously been crying for quite some time.

"Good morning. Can I get you some coffee?" He got up from his place and pulled out a chair for Pepper. "Is everything alright?"

"I don't know Bruce, I really don't know anymore… I really want to be there for him, but he is doing everything he can to push me away… I know it is not his fault but …" Pepper was trying her best not to burst into tears. She decided that it was neither time nor place for this discussion. She was not even sure, if Bruce was the person she wanted to have that conversation with.

"I am going to fly to Tokyo today; there is a conference that I must attend. I will be gone for a couple of days. That will give us both some space…"

Bruce took a deep breath. He knew that there was going to be trouble. He had noticed that Tony had become increasingly irritable in the past couple of days. Jarvis and Dummy were getting the brunt of it, as Tony was spending best part of the day alone in the lab again. If he did come out, any interaction he had with others seemed to end up in an argument. Nicola did warn him that it was not uncommon with Sertraline to initially worsen anxiety symptoms and give patients a 'bit of an edge', as she had nicely put it. She was a bit worried about how Tony was reacting to the medication and was seeing or calling him every day to keep an eye on him, whilst the dose was slowly titrated up. Unfortunately Tony had fallen out with her two days ago and refused to go to his appointment. Bruce considered his options and decided to leave Tony to his own devices for the time being. Jarvis was constantly keeping an eye on him and would let him know, if anything untoward was going on.

Nicola sat in her office, trying to clear her desk of outstanding paper work. She was looking forward to the weekend ahead. She had nothing in particular planned, but she felt that she needed some rest to recharge her batteries. She sighed deeply when she heard the phone ring. It was never good news on Friday afternoon. She was not exactly surprised to hear Jarvis on the other side.

"I'm very sorry to disturb you but Doctor Banner requests, if you could assist him in the Tower as a matter of urgency." Nicola could swear that she could hear anxiety in Jarvis voice. Surely that was not possible.

"What's going on Jarvis?"

"Sir seems to have developed a sudden suicidal ideation and proceed to act on those plans with a surprising haste…"

"I see… Can I speak to Bruce?" The line went silent. Nicola battled herself in her mind as she waited for Bruce to come to the phone. She knew that things were not going smoothly, but she clearly failed to anticipate the impending crisis.

"Hello, Nicola, I know that you don't do home visits as principle, but I really don't think that this can wait… I don't know… should we go to psychiatric ER…" From the tone of Bruce's voice Nicola knew straight away that they were in some serious trouble. "This whole situation makes me feel a bit angry… if you know what I mean… I don't know what to do…"

"Slow down Bruce. Take a deep breath … Just tell me what exactly is going on." Nicola tried to sound calm and reassuring, but she had alarm bells going off in her own head. If Bruce is going to 'turn' this is going to turn into a right mess.

"I am not sure. Tony was growing restless all day long. Tearful, irritable. He has not slept for at least 48 hours. This morning he had an argument with Pepper. Nothing out of the ordinary. Next thing I know I have found him in the lab counting out a stash of pills and talking about ending it all. I can't reason with him. I have never seen him so agitated before. I just don't know what to say to him…"

"Have you got anything that you can give him to help him to calm down? Some benzodiazepines?"

"I have some lorazepam in my bag." Bruce kicked himself for not thinking about this earlier.

"Great, that should take the edge off it. I will be there in next half an hour"

On arrival Nicola headed straight for the lab. She was quite alarmed by the sounds of commotion that she could hear as she was walking along the corridor.

"What is going on Jarvis?"

"Dr Banner did attempt to act on your suggestion however Sir would not accept the medication. He seems to believe that Dr Banner is attempting to poison him. I find that idea highly irregular. Also, I can't quite understand how the strong resistance to perceived attempts at being poisoned can coexist with the desire to consume a lethal amount of Atenolol tablets…"

Nicola wondered, if it was possible for Jarvis to experience emotions. He did sound genuinely worried. "Jarvis, the technical term for this would be… madness… It is hard for anyone to relate to. There is no logic behind it…" Nicola arrived at the entrance to the lab. "Can you let me in?"

"Certainly. Please, proceed with caution."

On entering the lab Nicola was faced with a scene of utter destruction. Tony was sat on the couch next to Steve, who was trying his best to keep him in place, whilst Bruce was attempting, to no avail, to persuade Tony that he meant him no harm. When he saw Nicola, he stood up and took her to the side to speak out of Tony's earshot.

"Thank you for coming. I really appreciate it. I am out of my depth here. I mean, there is anxiety, there is depression, I have been there myself… but this is … I don't know what this is…"

"This is most likely a medication induced mixed episode, form of an agitated depression. I think we have moved beyond a point when I could talk him down… Do you have any injectable sedatives?"

"Hmm, I don't know. Tony keeps a crash trolley in here. There should be something with the intubation kit. Touch wood, we never had to use it before." Bruce proceeded to rummage through the draws and returned with a prefilled syringe.

"Midazolam. That should do the trick. I am not sure, how ethical or legal for that matter it is to inject him against his will…"

"I think the only alternative would be to take him to the hospital and have him formally committed. That would address the legal predicament. I am not sure about the best interest principle…"

"Oh for God's sake, is it really the time for philosophical discussions? I definitely don't have any objections to giving him something." Natasha took the syringe from Bruce's hand and before he had a chance to protest, injected the contents into Tony's thigh.

Nicola looked at Bruce with slight alarm in her eyes. "How much was in that syringe?"

"20mg." Bruce swallowed hard as he watched Tony stop struggling and become completely limp like a rag doll.

"Get him on the floor Steve". He barked angrily.

"Congratulations, Natasha on your first ever general anaesthetic." He kneeled by Tony's head and leaned over to check for breathing.

"Vitals, Jarvis!"

"Blood pressure reading comes at 80/60. Other parameters are within normal limits however oxygen saturations are dropping."

"Shit, he is obstructing his airway." Bruce could hear the unmistakable snoring like sound coming out with every breath that Tony made.

"To be expected really. Here, that should sort it." Nicola threw Bruce a plastic guedel airway from the crash trolley.

"Fantastic. Have you got any IV fluids in there? We need to get his BP up."

"Is he going to be OK?" Natasha asked quietly as she watched Nicola pull out a bag of normal saline and a giving set.

"Yeah, don't worry about it. He is just going to sleep for … quite some time." Nicola decided that it was not particularly helpful at this stage to point out to Natasha all the potential perils of administering an anaesthetic in such an uncontrolled manner, particularly taking into account Tony's heart condition.

Nicola handed Bruce a cannula and busied herself running the fluids through. She watched from the corner of her eye, as he struggled to obtain IV access.

"Shit, how many of those cannulas have we got?" Bruce's hands were shaking. He was trying his best to remain calm and deal with the situation in a logical and collected manner, but he felt the anger rising up in him. The last thing they needed at the moment was for the other guy to show up.

"Don't worry, we have plenty… Let me try." Nicola took another venflon out of the packet and inserted it into the vein at the wrist.

"Here, this one always does the trick for me… Do you think it is wise to stay and play here or should we call for cavalry and get him into a hospital?" Bruce was relieved to see how confident Nicola seemed to be in dealing with the acute situation. He figured that having spent a lot of time working with NGOs, she maintained her skills in responding to emergencies. In a rural third world country, a doctor is a doctor and even a psychiatrist needed to be prepared to occasionally save the day. Between the two of them, they could manage the situation, at least for the time being.

"It is an IM injection, it should reach its peak effect in the next hour or so. If he carries on breathing on his own, then I think we are fine here. Otherwise, we will have to rethink the situation. We have a lot of kit here, but not a ventilator… Honestly Nat, what were you thinking." Bruce shook his head in resignation.


	9. Burning the midnight oil

Four hours later Tony was still deeply unconscious. With the help of the other Avengers Bruce had managed to settle Tony in his bedroom with oxygen and IV fluids running. He was now sat at the bedside watching Tony's chest rise and fall.

"That is why pulse oximeters were invented, Bruce. If there is a problem, an alarm will go off. You don't need to observe him so intently." Nicola smiled, peering at Bruce over the book she was reading. She was stretched in an armchair with her legs resting on the bedside cabinet. Bruce wondered if what had happened today was a regular occurrence in psychiatric hospitals as Nicola did not seem to be particularly phased by it.

"I know… I just don't think I could concentrate on anything else anyway at the moment… I really appreciate your help by the way. I have administered plenty of anaesthetics in a shack with no equipment to speak of, but I don't think that I could have handled this one on my own."

"I think you did great. If it was my friend, I would be probably running around like a headless chicken." Nicola laughed quietly and pulled up the blanket she was wrapped in. She was not going to comment on how grateful she was that Bruce managed to stay in control. She had seen Hulk in action, back then in Cambodia and she really did not fancy a face to face encounter in a crumpled space of the lab.

"Do you think he will be ok when he wakes up? I mean mentally…" Up to now Bruce had busied himself making sure that Tony's blood pressure was stable and airways opened. He concentrated on being a doctor and tried not to think too much about what had happened earlier on in the afternoon. Now that the crisis was over, he started to worry how he was going to handle Tony when he does finally come around.

"I don't know… It is hard to predict. He may pick up right where he left off, in which case we will probably have to look at a hospital placement for a little while."

"He doesn't like hospitals…"

"I know… I don't think that there would be a viable alternative though. Dysphonic mania has a rather high morbidity and mortality rate… Depressed mood and suicidal ideations combined with high energy, impulsivity and disinhibion is a recipe for disaster…"

"We can keep an eye on him here; it is not that difficult with Jarvis …"

"I am not too worried about the supervision aspect. I am more concerned for you guys. It is very draining to look after someone in that state of mind… particularly when it is a family member or a close friend."

"I have never felt so helpless like I did last night. I have all my medical training to fall upon and yet I just didn't know what to do. It was like I was facing a brick wall and could not see a way through…"

"Are you familiar with a concept of transference?" Bruce shook his head to indicate that he wasn't.

"I guess you could look at it as psychiatric version of contagion... It is an unconscious redirection of feelings from one person to another. When you are faced with someone acutely suicidal, some of their hopelessness is going to rub on you. You connect with the feelings, but you can't understand as they are in conflict with your own self-preservation instinct. It creates a very uncomfortable cognitive dissonance..." Nicola's mind wondered briefly to the time in her first year of residency, when she sat late at night in psychiatric ER talking to a girl, not much older than herself… She took a deep breath and sharply brought herself back to the present moment.

"How do you stop it from happening?" Bruce was hoping that Nicola was going to share with him some trade secret that maybe allows psychiatrists to become immune to those uncomfortable emotional shifts. He thought that he had a lid on his emotions. Years of training in various meditative techniques aimed at keeping the 'other guy' at bay should have equipped him to deal with this sort of situation. Yet he had almost lost it last night.

"You can't. It is inevitable. No matter how much training and professional experience you have, when dealing with someone who is as distressed as Tony was yesterday, it is going to rub on you in one way or another and strike a chord… The secret is to use it to your advantage. When you recognise the feeling in yourself and analyse where it came from, it helps you to understand what your patient is going through. The tricky part is to strike the right balance. You need to allow yourself to experience those feelings but at the same time remain in the role of a detached observer. Acknowledge the distress, examine it, but do not let it overtake you… otherwise you are screwed." Nicola smiled and stopped talking as she realised that she was giving Bruce a mini lecture on psychoanalytical techniques when it was not really called for.

"Some job you have, honestly." Bruce smiled back, cleaning his glasses with the sleeve of his shirt. He looked exhausted. Not surprisingly.

"Why don't you try and get some sleep? There is no point in both of us sitting here. We are over the worst now. We will think about what we need to do in the morning when we have a better idea where we stand."

"Are you sure? I could take the first watch." Bruce did feel very tired, but he did not want to impose on Nicola any more than they already did. It was not her usual practice to do home visits, never mind spent the whole night playing an anaesthetist.

"Yes go ahead. I want to have a word with Jarvis before I go to bed. There are some things playing on my mind… I need to figure out what exactly went wrong. You can take over in a couple of hours."

When Bruce returned after having caught a couple of hours of broken sleep, he found Nicola engrossed in a deep conversation with Jarvis. He swore he had recognised a quote from Tolstoy being mentioned.

"Are you two enjoying yourselves, Jarvis?" Bruce asked with a grin.

"Dr Taylor is helping me to understand the nature of human mind. I am afraid that despite her expert tuition I still remain very confused about the nature of yesterday events, Sir."

"I tried examples from literature, but I think suicidality is the kind of concept that will always be difficult for Jarvis to grasp. It defies logic on every level… Are you ready to take over?" Nicola scrambled to her feet and stretched out.

"I have asked Dummy to get one of the guest bedrooms ready. You will find towels and toiletries in there. I hope you find the nightwear suitable, I couldn't get anything else… Dummy will show you where the kitchen is. If you need anything later on, just speak up. Jarvis will hear you anywhere in the house."

"Thank you. I will see you in the morning."

Nicola tiptoed out of Tony's bedroom and followed Dummy along the corridors. She was grateful to know that she could call Jarvis for assistance at any time as she was sure that with her poor sense of direction she would never be able to find her way inside the tower. At the same time she had a slight sense of unease knowing that something or someone, she was not quite sure which, was constantly observing and listening.


End file.
